Results of irradiation or chemoirradiation following resection of gastric adenocarcinoma

Purpose: To evaluate the results of postoperative irradiation +/- chemother apy for carcinoma of the stomach and gastroesophageal junction, Methods and Materials: The records of 63 patients who underwent resection f or stomach cancer were retrospectively reviewed. Twenty-five patients had c omplete resection with no residual disease but with high-risk factors for r elapse. Twenty-eight had microscopic residual and 10 had gross residual dis ease. Doses of irradiation ranged from 39.6 to 59.4 Gy with a median dose o f 50.4 Gy in 1.8 Gy fractions, Fifty-three of the 63 (84%) patients receive d 5-fluorouracil (5-FU)-based chemotherapy. Results: The median duration of survival was 19.3 months for patients with no residual disease, 16.7 months for those with microscopic residual diseas e, and 9.2 months for those with gross residual disease (p = 0.01), The amo unt of residual disease also significantly impacted locoregional control (p = 0.04), Patients with linitis plastica did significantly worse in terms o f survival, locoregional control, and distant control than those without li nitis plastica, The use of 4 or more irradiation fields was associated with a significant decrease in the rate of Grade 4 or 5 toxicity when compared to the patients treated with 2 fields (p = 0.05), Conclusions: There was a significant association between survival and exten t of residual disease after resection as well as the presence of linitis pl astica. Distant failures are common and effective systemic therapy will be necessary to improve outcome. The toxicity of combined modality treatment a ppears to be reduced by using greater than 2 irradiation fields. (C) 2000 E lsevier Science Inc.